PROGNOSTIC VALUE OF RED CELL DISTRIBUTION WIDTH IN NEONATAL SEPSIS: A PROSPECTIVE OBSERVATIONAL STUDY FROM A DISTRICT HOSPITAL IN SOUTH INDIA

Dr. Girish Hiremath; Dr. Prabhakar Dharmatti; Dr. Harsha; Dr. S G Matti

Authors

Dr. Girish Hiremath Associate professor, Department of paediatrics, KIMS, Koppal, Karnataka, India. Author
Dr. Prabhakar Dharmatti Resident, Department of paediatrics, KIMS, Koppal, Karnataka, India. Author
Dr. Harsha Assistant Professor, Department of Paediatrics, KIMS, Koppal, Karnataka, India Author
Dr. S G Matti Professor and Head, Department of Paediatrics, KIMS, Koppal, Karnataka, India – 583231. Author

Keywords:

Neonatal Sepsis, Red Cell Distribution Width, Biomarker, C - reactive protein, Septic Shock, Neonatal Mortality.

Abstract

Background: Neonatal sepsis is a leading cause of neonatal mortality, and early identification of severity remains challenging in resource-limited settings. Red cell distribution width (RDW), a routinely reported haematological index, has emerged as a potential low-cost prognostic biomarker in sepsis. Objective: To evaluate the prognostic value of RDW in neonatal sepsis and its correlation with disease severity, and to identify associated risk factors. Methods: This prospective observational study enrolled 100 neonates aged 1–28 days with clinical features suggestive of sepsis to Koppal Institute of Medical Sciences, Koppal, India. Institutional ethical clearance and written consent from parents or guardian was taken. Neonates were classified as no sepsis, sepsis, or septic shock. RDW, complete blood count, CRP, and blood culture were assessed on day 1 and day 3 of illness. Sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis were used to evaluate RDW as a predictor of CRP positivity. Results: Mean RDW increased with severity: 15.99 in neonates without sepsis, 17.43 in sepsis, and 18.25 in septic shock (correlation coefficient 0.49, moderate positive correlation). On day 1, RDW-CV (cut-off ≥16.00%) predicted CRP positivity with 88.9% sensitivity and 51.1% specificity (AUC 0.689, p=0.008), while RDW-SD (cut-off ≥66.30 fL) showed 50.0% sensitivity and 78.7% specificity (AUC 0.585, p=0.048). Blood culture was positive in 20% of neonates, most commonly Klebsiella pneumoniae (9%). Mortality was higher among outborn (20.3%) than inborn (12.2%) neonates. Conclusion: RDW rises progressively with the severity of neonatal sepsis and is a highly sensitive, inexpensive, and readily available screening biomarker. Its moderate specificity limits its use as a standalone diagnostic test, and it should be interpreted alongside CRP and clinical assessment. Larger multicentric studies are recommended to validate cut-off values before routine clinical adoption.